Graduated: 2021
NPI: 1396415113
Practice Locations (2)
STATE OF MISSOURI
600 E 5TH ST, FULTON STATE HOSPITAL
FULTON, MO 652511793
5735924100
OSAGE BEACH CENTER FOR BEHAVIORAL HEALTH, LLC
840 PASSOVER RD
OSAGE BEACH, MO 650652834
5733020319
Source: CMS National Downloadable File, September 2026.